| NPI | 1487192118 |
|---|---|
| Former Name | TARA JAMIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 5494) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2022-03-22 |